Bilateral Breast Lumps Research Articles

Reduction Mammoplasty for Bilateral Gigantomastia and Multiple Breast Fibroadenomas in an 18-Year-Old Girl

Gigantomastia is a huge physical and psychological burden on affected patients, and it usually reduces their quality of lives drastically. Bilateral gigantomastia coexisting with multiple bilateral breast lumps is a rare condition. We have reported the case of an 18-year-old adolescent who presented with bilateral gigantomastia and multiple fibroadenomas in both breasts that were treated with reduction mammoplasty using the inferior pedicle with inverted-T technique. Treating bilateral gigantomastia using the inferior pedicle with inverted-T technique gives the best esthetic and functional results. Total resection weight of more than 1000 g should not be an absolute contraindication to use of inferior pedicled technique.

Metastases to breast from primary lung cancer

BackgroundMetastatic involvement of the breast is relatively rare and has an incidence of 0.5–3%. Lesions that metastasize to the breast may produce changes that look similar to those of primary breast cancer on mammography, but they are more likely to be multiple and are frequently bilateral.Case presentationA 38-year-old female complaining of progressive proptosis with bilateral palpable breast lumps. She was referred to the breast imaging unit to evaluate the nature of those breast lesions, diagnostic mammography, and complementary ultrasound was done that revealed multiple variable-sized well-defined masses scattered all over their parenchyma. True cut biopsy was taken from one of them that show metastatic carcinoma of non-mammary origin. Immunophenotyping revealed neuroendocrine carcinoma of lung origin. A metastatic workup was done that revealed horrible metastatic deposits in multiple organs and the primary was found in the lung.ConclusionsMetastasis to the breast from extra-mammary carcinomas is extremely rare. The most common types are malignant melanoma, secondary lymphomas, and tumors of neuroendocrine origin like Small cell carcinoma. Histopathology and sometimes immunophenotyping can provide the diagnosis.

Lupus Mastitis in a Young Female Mimicking a Breast Carcinoma; a Rare Entity Through a Case Report and Review of the Literature.

Lupus mastitis (LM) is a rare presentation of lupus panniculitis (LP) that usually affects women of childbearing age and may mimic malignancy. The condition is recurrent and progresses along with the underlying disease. Breast pathology that may be associated with LM includes fat necrosis, calcification, fibrosis, scarring, and breast atrophy. Therefore, LM should be considered in the differential diagnosis of a suspicious breast mass on mammography or ultrasound, particularly if the patient has a background of systemic lupus erythematosus (SLE) or discoid lupus erythematosus (DLE). Traumatic procedures such as surgery or biopsy may worsen the condition and it is advisable to avoid biopsy if the diagnosis can be established through accurate patient history, with identification of typical clinical and radiological features. Thus, awareness of the radiologic and clinical features of LM is essential to avoid unnecessary interventional procedures that carry the potential for disease exacerbation. The authors present here the imaging findings of LM in a 37-year old female with SLE, which presented as bilateral palpable breast lumps.

Rhabdomyosarcoma Presenting as Metastatic Abdominal or Chest Lumps: Report of 2 Cases

Rhabdomyosarcoma is a malignant mesenchymal tumor with skeletal muscle differentiation. It is the most common soft tissue sarcoma in children and adolescents. Its incidence is 4.5 cases per 1 million people aged 0-20 year. Embryonal, alveolar, pleomorphic and sclerosing /spindle cell types are the major variants of rhabdomyosarcoma. Embryonal rhabdomyosarcoma is the most common type. Rhabdomyosarcoma is highly aggressive and usually patient presented with pressure symptoms or metastasis. We are reporting 2 cases of rhabdomyosarcoma with one patient presented with abdominal wall nodules and other patient with bilateral breast lumps.

Bilateral male idiopathic granulomatous mastitis of the breast: a case report

: Idiopathic granulomatous mastitis (IGM) is a rare benign inflammatory disease of the breast of unclear etiology, which can mimic breast cancer or infection. It is usually seen in parous women and is very seldom seen in males, with a few reported cases in the literature. We report a rare case of a 46-year-old male presenting with bilateral breast lumps and left-sided peri-areolar discharge from sinus tracts, who had failed antibiotic treatment. Bilateral mammogram, ultrasound, and core needle biopsies of the breast masses were performed, which revealed pathological findings consistent with granulomatous mastitis. The case was reported as bilateral IGM after exclusion of all known secondary causes of the disease, specifically tuberculosis and corynebacteria infection, as well as autoimmune diseases. To the best of our knowledge, this is the first case presentation of bilateral IGM in a male. Our patient was treated pharmacologically, initially using corticosteroids followed by methotrexate, and demonstrated good response with decreased swelling bilaterally and resolution of left peri-areolar discharge. Therefore, similar to women, IGM can present with bilateral disease in males. It is important for clinicians to be aware of IGM and its presentation in males to be able to correlate typical clinical findings with imaging and biopsy in order to avoid extended antibiotic therapy.

Ovarian clear cell carcinoma with bilateral breast metastasis

Clear cell carcinoma of ovary (CCCO) is a rare subtype of epithelial ovarian tumors that is associated with poorer prognosis due to relative chemoresistance and higher chances of recurrence. Metastasis to the breast is extremely rare. Here, we report a case of ovarian cancer with metastasis to bilateral breasts. A 46-year-old female presented with pain abdomen and mild distension. Examination revealed pelvic mass and bilateral breast lumps. Staging laparotomy and fine-needle aspiration cytology from bilateral breast lumps were done. Histopathology revealed CCCO with metastasis to bilateral breasts. Due to the rarity of CCCO, there are no standard guidelines for management. The patient should be subjected to maximum cytoreduction and chemotherapy. Metastasis to the breast from ovary can occur either due to retrograde lymphatic or hematogenous spread that confers a worse prognosis. Hence, in a patient with breast mass especially with a history of malignancy, breast metastasis should be differentiated from primary breast cancer.

EXTRAMEDULLARY PLASMACYTOMA: A RARE PRESENTATION

TOPIC: Disorders of the Mediastinum TYPE: Medical Student/Resident Case Reports INTRODUCTION: Extramedullary plasma cell tumors are unusual. Their presence in the breast tissue is extremely rare. We present a case of incidental diagnosis of a primary extramedullary lesion in a previously healthy female. CASE PRESENTATION: 45-year-old female presented with a several-week history of persistent, sharp back pain radiating to the epigastric region associated with abdominal pain and worsening numbness of the left lower extremity. She complained of a growing mass over her sternal region that she noticed five months prior. Vital signs were within normal limits, and physical exam noted a large, non-mobile, firm nodule located over the sternum. Bloodwork was unremarkable. Computed Tomography of the abdomen and pelvis revealed multiple bulky masses involving the anterior chest wall, skeleton, pleural space, and vertebral bodies (T4 and T5) with extension to the spinal canal in addition to hepatosplenomegaly. Magnetic Resonance Imaging of the spine revealed moderate cord compression at T3-T4, with no acute neurosurgical intervention recommended. Biopsy of the anterior chest wall mass revealed a plasma cell neoplasm with plasmablastic features, and flow cytometry noted approximately 46% cytoplasmic lambda light chain restricted plasma cells with expression of CD38, CD19, CD20, CD56, and CD117 with negative CD45. Bone marrow biopsy confirmed plasma cell myeloma, with the neoplastic cells in both biopsies morphologically identical. The patient was diagnosed with multiple myeloma with cord compression and started on radiation and chemotherapy. 11 months after treatment initiation, she presented to our office with a 2cm mobile, firm, irregular mass in the upper outer quadrant of the right breast and a mass in the lower inner left breast confirmed by mammogram. There was no associated nipple discharge, pain, and weight loss. Core biopsy of the masses diagnosed plasma cell myeloma, with the tumor cells morphologically similar to those of the anterior chest wall mass. DISCUSSION: Plasmacytoma is a malignant proliferation of plasma cells[1,2,3] and is considered to be extramedullary when situated outside the bone marrow. It may occur in the lungs, gastrointestinal tract, spleen, pancreas and very rarely in the breast [4-7]. The likelihood of diagnosing a breast extramedullary plasmacytoma is approximately 0.01%[4,5,6]. Confirmation of the diagnosis is by the demonstration of monoclonal plasma cells and plasma cell markers, such as CD38 from immunohistology. Bone marrow biopsy is required to confirm or rule out the presence of plasma cells in the bone marrow. Radiation therapy over a course of four weeks is the treatment of choice [8]. Smaller lesions may be treated with surgery alone. CONCLUSIONS: Extramedullary plasmacytoma involving the breast is a very rare, underdiagnosed form of multiple myeloma, and should be part of the differential for breast masses to avoid misdiagnosis and improve outcomes. REFERENCE #1: Carson C P, Ackerman L V, Malty J D. Plasma cell myeloma. Annals of Clinical Pathology. 1955;25:849–888. [PubMed] [Google Scholar] REFERENCE #2: Cutler C W J. Plasma cell tumour of the breast with metastases. Annals of Surgery. 1934;100:392–395. [Google Scholar] REFERENCE #3: Booomberg TH, Glees JP, Williams JE. Bilateral breast lumps; an unusual feature of extramedullary plasmacytoma. Br J Radiol. 1980;53:498–501. [PubMed] [Google Scholar] DISCLOSURES: No relevant relationships by Muhammad Hanif, source=Web Response No relevant relationships by Samia Hossain, source=Web Response No relevant relationships by SANA MULLA, source=Web Response No relevant relationships by Ruqqiya Mustaqeem, source=Web Response No relevant relationships by Rajesh Thirumaran, source=Web Response No relevant relationships by Vihitha Thota, source=Web Response

Epithelioid rhabdomyosarcoma: A rare case report mimicking carcinoma breast

Rhabdomyosarcoma (RMS) is an unusual sarcoma in adults. There are four main types of RMS described in the literature, including embryonal, alveolar, pleomorphic, and spindle cell type. Epithelioid RMS is a relatively newer form of RMS described in the literature, with little information regarding the natural course and management. We present a rare case of a young woman with metastatic epithelioid RMS, with an atypical presentation with bilateral large breast lumps, large ovarian mass progressing rapidly to metastasize, involving multiple sites. It has an aggressive clinical course with poor response to therapy.

Mantle cell lymphoma presenting as synchronous bilateral breast lumps and arm mass.

Mantle cell lymphoma presenting as synchronous bilateral breast lumps and arm mass.

Metastatic Melanoma in the Breast with unknown Primary

Secondary in the breast is a very rare condition but may occur usually from contralateral breast and from others like lymphoma, melanoma, ovarian tumors, and pulmonary malignancies and malignancies of the gastrointestinal and genitourinary tract. Among the primary diseases, melanoma is notorious and unpredictable in its metastatic potentiality and organ of dissemination. There are few reported cases with metastatic melanoma in the breast. We report a case of metastatic deposits in the breasts of a 45year-old lady who presented with bilateral breast lumps with axillary lymphadenopathy having no primary site of melanoma.
 Journal of Surgical Sciences (2015) Vol. 19 (2) : 72-74

Outcome of open excisional breast biopsies in Abakaliki, South-East Nigeria.

Introductionopen excisional breast biopsy is a known modality for treatment of breast lumps especially in developing countries. Other sophisticated methods are available for management of breast lumps in more advanced nations. Our aim in this study was to review the outcome of open excision breast biopsies in our setting with a view to improving patient management.Methodsthis study was conducted at the National Obstetric Fistula Centre, Abakaliki, South East Nigeria among women who had excision breast biopsy between January 2015 and December 2016. Data was analysed using Statistical Package for Social Sciences (SPSS), version 21.Resultsa total of 107 case folders were reviewed in this study. The mean age of the women was 27 ± 10 years. Overlying breast incision was the preferred route in 78(72.9%), periareolar incision in 28(26.2%), and Gillard Thomas's method (infero-lateral submammary sulcus incision) used in one patient with bilateral multiple breast lumps (0.9%). The complications recorded in this study were haematoma in 3(2.8%), wound infection in 5(4.7%) and wound breakdown in 1(0.9%). Hypertrophic scar was found in 2(1.8%) patients at follow-up. Overall, most patients were satisfied with the aesthetic outcome of their surgery.Conclusionopen excision breast biopsy is a useful modality for management of breast diseases in our setting. Complication rates are minimal. Both overlying and periareolar breast incisions results in aesthetically satisfactory scar in our practice. Inferior-lateral sub mammary sulcus skin incision is useful when the lumps are multiple and located at different quadrants of the breast. Appropriate use of drain helps to reduce the incidence of haematoma.

Rare presenting features of carcinoma of stomach – Leptomeningeal carcinomatosis, breast metastasis, malignant pleural effusion, and dermatoses: A report of two cases and review of literature

Gastric cancer can have protean manifestations, usual symptoms mimicking those of peptic ulcer disease. Gastric adenocarcinomas have rarely been reported with leptomeningeal carcinomatosis (LMC) and dermatoses as initial presenting features. It is also difficult to diagnose breast metastasis of gastric carcinoma due to its rarity. We report two such cases with rare initial presentation. Our first case was a 46-year-old male who presented with LMC. Our second case was a 24-year-old male whose initial complaints were shortness of breath, bilateral breast lumps, and skin discoloration. Both cases on further investigations were found to have primary tumors in the stomach.

Primary Non Hodgkins Lymphoma Of Bilateral Breasts: A Rare Entity

Extranodal Non-Hodgkin's Lymphoma (NHL) of the breast is a rare entity, repr esenting 0.04-1.1% of malignant tumours of the breast. Most breast lymphomas are the non-Hodgkin’s B cell type, with DLBCL being the most common. We present the case of a 32 years old female who presented with bilateral hard breast lumps, which were clinicoradiologically thought to be carcinomas. But on histopathology and immunohistochemistry, it was finally diagnosed as alymphoma. Primary and secondary lymphomas of the breast, though rare, should be considered in the differential diagnosis of breast malignancies. DOI: 10.21276/APALM.1335

Metastatic embryonal rhabdomyosarcoma to the breast: a case report and review of the literature

A 19-year-old fertile Caucasian female, with a medical history of embryonal rhabdomyosarcoma in the left upper extremity at the age of 17, presented with enlarged lymph node of left axilla. Fine needle aspiration (FNA) cytology of axillar lymph node revealed a metastatic malignant neoplasm, consistent with the primary embryonal rhabdomyosarcoma. Four months later, breast clinical examination revealed the presence of multiple hard and immobile masses located in both breasts. Ultrasound detected multiple opacity areas and ultrasound-guided FNA cytology was performed on two bilateral breast lumps. The final cytology diagnosis of FNA -using ThinPrep ® technique- was “Positive morphologic and immunocytochemistry findings of metastatic malignant neoplasm of mesenchymal origin, consistent with patient’s history-embryonal rhabdomyosarcoma”. Today the patient is under first line chemotherapy and in good physical condition.

Bilateral Adenomyoepithelioma of the Breast Presenting With Breast Abscess in a Lactating Woman: A Case Report

The term adenomyoepithelioma has been applied to a broad range of biphasic lesions composed of epithelial and myoepithelial cells. They show diverse morphologic patterns due to the admixture of the two components which may lead to a diagnosis of malignancy. We present a case of bilateral adenomyoepithelioma in a lactating woman who had a concomitant breast abscess. A 25-year-old lady presented with bilateral breast lumps since 2 years, with acute pain. With a clinical diagnosis of an abscess, superimposed on fibrocystic disease, drainage of abscess, and lumpectomy was performed. The clinicopathological features of this entity are discussed.

Bilateral invasive duct carcinoma, phyllodes tumor and multiple fibroadenomas of breast associated with lymph node metastases - rare coexistence.

Concomitant occurrence of phyllodes tumor with an in situ or invasive carcinoma in the breast is an uncommon phenomenon and has been reported sparingly. We describe a rare case of simultaneous bilateral intraductal and infiltrating duct carcinoma with coexisting fibroadenomas and phyllodes tumor. To the best of our knowledge, only 19 cases of invasive carcinoma with phyllodes tumor have been reported so far and lymph node metastases has been described only once. A 43year-old woman presented with multiple bilateral breast lumps. Core biopsies revealed phyllodes tumor in the right breast and invasive duct carcinoma of the left breast. Simple mastectomy done for right breast showed foci of invasive carcinoma arising in phyllodes tumor. Metastasis was detected in the left axillary lymph nodes. This case is being reported to create awareness of this rare transformation, which has significant prognostic and therapeutic implications.

Bilateral Breast Lumps as a Presentation of Disseminated Squamous Cell Carcinoma of Lung

We present the case of a 65-year-old female who presented to our hospital with nodular swelling in her breast that first appeared in the right upper quadrant 10 months earlier, followed by involvement of the left upper quadrant along with nodular swelling in the right inguinal region for the past six months. She was also complaining of breathlessness on exertion and right-sided pleuritic chest pain for the past one year. Her chest X-ray showed well defined consolidation in the right lower lobe of the lung with pleural effusion. Further pleural tap showed malignant cells with squamous differentiation. Fine needle aspiration cytology (FNAC) from breast lumps was suggestive of malignant cells with morphology of cells likely to be squamous. CT-guided biopsy of the lung mass showed moderately differentiated squamous cell carcinoma of the lung. She succumbed to her illness following severe respiratory distress. Breast lump secondary to lung malignancy is very rare. Squamous cell carcinoma presenting as breast metastasis is a very rare presentation and reported in few cases. No previous case reporting bilateral breast lumps as a presentation of squamous cell carcinoma of the lung could be found in the literature.

English

Primary breast lymphoma (PBL) is a very uncommon condition having a poor prognosis, that accounts for 0.05-0.53% of all malignant disease of breast and 2.2% of extranodal malignant lymphoma. A 60yrs female presented with shortness of breath and on examination bilateral breast lumps and left axillary lymphadenopathy were found. Further evaluation done and by cytological, histopathological and immunohistochemical (IHC) correlation a final diagnosis of Non Hodgkins Lymphoma (B cell type) was made. INTRODUCTION: PBL is a very uncommon condition constituting 0.05-0.53% of all malignant disease of breast but it is most frequent hematopoietic tumor of breast.10 MATERIALS AND METHODS: Fine needle aspiration cytology (FNAC) done under aseptic precautions using 22 gauge needle. Excision biopsy done under general anaesthesia of both right and left breast lumps and left axillary lymph node. H & E stain done. Immunohistochemistry (IHC markers -CD 3, CD 20, CD 30). Consent –Patient died 4 months back , Consent taken from kin[son] RESULTS: On examination-bilateral breast lumps and left axillary lymphadenopathy were found. Left breast lump measuring 5x5cm, hard in consistency, in upper central quadrant having restricted mobility. Right breast lump measuring 2x2cm, hard in consistency, in central quadrant, freely mobile. Left axillary lymphadenopathy measuring 2.5x2 cm, solitary, firm, mobile. No generalized lymphadenopathy[cervical, right axilla, inguinal region examined] Investigations: Routine investigations done: CBP Hb-9.7gm%,RBC-3.4 million,WBC-7,300/cumm,N-66% L-30% M2%,E-2%,Platelet-2,76,000/cumm CUE albumin ++,sugar nil,EC-2-4/hpf, pus cell plenty/hpf X-RAY CHEST -NAD ESR first hour-120mm,second hour-140mm LDH -512 U/l BLOOD UREA 60mg% BONE MARROW ASPIRATION-within normal limits

Multiple myeloma presenting as bilateral breast lumps in pregnant woman

Multiple myeloma (MM) is a systemic disease in the elderly. Its incidence in patients younger than 40 years old and especially in pregnant women is extremely rare. MM may involve extraosseous sites, and only in rare cases it is observed in the breast. We describe the case of a 39-year-old woman diagnosed with an IgG lambda light-chain MM (Durie-Salmon stage IIIA, International Staging System II) in the 26th week of pregnancy, presenting with bilateral breast lumps. Dexamethasone (20 mg/m(2)/day on days 1-4, 9-12, and 17-20) was given as an induction agent to decrease tumor mass during pregnancy. Adverse response to dexamethasone was minor with excellent tolerance. A healthy baby was delivered at week 34 of gestation. Breast nodules revealing MM are extremely rare. Clinical and radiological features are atypical. Presentation during pregnancy is extremely rare, making anti-MM treatment potentially challenging.

Bilateral myoid hamartoma of breast: An exceptionally rare lesion

Breast hamartomas (BH) or Fibroadenolipoma are extremely rare breast lesions. They are benign, focal malformations that resemble a neoplasm in the tissue of its origin. We describe a case of a 48 year old woman with bilateral breast lumps for the past 18 months and 6 months which were gradually increasing in size. FNAC smears revealed only clusters of benign ductal epithelial cells. Lumps were excised and histopathology revealed predominantly stromal smooth muscle bundles (proved by immunohistochemistry) along with scattered intact terminal duct-lobular units, dilated ducts and entrapped islands of mature fibroadipose tissue. A diagnosis of Bilateral Myoid hamartoma of breast was given. To the best of our knowledge till date no case of bilateral MH of breast has been reported in the literature. We report the first case of bilateral MBH highlighting its morpho-immunophenotypic features.